If you are hired; can you provide proof that you are eligible to work?

Yes

No

If using a visa to show proof of eligibility, what is the Effective Date?

Visa Expiration Date?

Have you ever worked for us before or for our sister restaurant Barking Frog? *

Have you ever been convicted of a felony? *

Do you have a current Food Handlers Permit and/or Alcohol Serving Permit? *

Previous Employment - Please Begin With Most Recent

Employer 1: *

Employer's Phone Number: *

City/State: *

Supervisor: *

Job Title: *

Starting Salary/Wage: *

Ending Salary/Wage: *

Main Duties: *

Employer 2:

Employer's Phone Number:

City/State:

Supervisor

Starting Salary/Wage:

Ending Salary/Wage:

Main Duties:

Reason for Leaving:

Employer 3:

Employer's Phone Number:

City/State:

Supervisor

Starting Salary/Wage:

Ending Salary/Wage:

Main Duties:

Reason for Leaving:

Education

High School: *

City/State: *

Did You Graduate?: *

College or Trade School:

City/State:

Did You Graduate?:

References

Full Name:

Company:

City/State:

Phone Number:

Full Name:

Company:

City/State:

Phone Number:

Other Information You Want Considered:

Applicant Agreement (Read Carefully Before Signing) *

All information provided by me is true and correct to the best of my knowledge. I understand omissions or
misrepresentations may result in rejection of my application or, if employed, may result in subsequent dismissal. I hereby authorize any former employer, person, school, firm or corporation listed hereon, including this company, to answer any and all questions related to employment and agree to release from liability and hold all persons harmless for giving any and all truthful information within their knowledge or records. I understand this is a preliminary application and not a contract to employ me. Furthermore, in the event I am employed, my employment shall be completely voluntary and may be terminated “at will” at any time by either myself or the company. I understand that no one other than the company owner has authority to enter into any employment agreement to the contrary. I agree to comply with all rules of the company as a condition of employment.

I Agree

I Agree

Today's Date: *

An Equal Opportunity Employer: Polar Bear, Inc. and our subsidiaries consider applicants for all positions without
regard to race, color, religion, creed, gender, sexual orientation, national origin, age, disability, marital or veteran status or any other reason prohibited by Federal, State or Local Laws.